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by Steven Reinberg

Nerve Blocking Procedure Fails to Impress in Weight Loss Study

Modest reduction not significantly better than diet drugs or other surgeries
TUESDAY, Sept. 2, 2014 (HealthDay News) -- A device intended to help with weight loss by blocking a certain nerve linked to appetite and metabolism failed to meet expectations in a trial among obese patients.
Using electric impulses to block the vagus nerve, which runs between the brain and stomach, researchers hoped to suppress feelings of hunger. And, they did, just not to the extent they anticipated.
"A device that safely blocks the nerve that connects the brain to the gut can help people lose weight," said lead researcher Dr. Charles Billington, an endocrinologist and weight management specialist at the University of Minnesota in Minneapolis.
Just not as much as had been hoped.
The device, which is similar in size to a pacemaker, is implanted in the patient's abdomen with its electrodes touching the vagus nerve at a point between the esophagus and the stomach. Periodically, the device delivers electric impulses that block nerve impulses leaving patients with less of an appetite and feeling fuller, the researchers say.
After a year, Billington's team had hoped to see the 162 patients with the device lose 10 percent more excess weight than the 77 patients given a sham device.
However, the margin of weight loss was only 8.5 percent in favor of the device compared to the sham procedure. Patients with the real device lost about 24 percent of their excess weight, compared with 16 percent among those with the sham device, the researchers found.
Moreover, fewer people using the device lost significant amounts of weight (20 or 25 percent of their excess weight) than the researchers expected.
The report was published Sept. 3 in the Journal of the American Medical Association.
Dr. Philip Schauer, a bariatric surgeon, and director of the Bariatric and Metabolic Institute, Cleveland Clinic, said that given the modest amount of weight loss with the device compared with diet and exercise alone, he "wouldn't jump on the bandwagon yet."
"On the one hand the study does validate this concept, but on the other hand the amount of weight loss was modest," he said.
The difference in overall body weight lost was 3 percent between the device group and the sham device group, according to the study. Schauer questions whether that's enough of a difference to recommend the device over diet and exercise.
"For this device to be competitive it has to come between the weight loss we are getting with surgery and drug therapy," he said.
Weight loss is generally 8 to 10 percent of body weight with currently available drugs for weight loss, Schauer said. Weight loss with surgery is in the range of 25 to 30 percent, he said.
"So with a device like this, which is lower risk than surgery but greater risk than taking a pill, it needs to achieve an additional 15 to 20 percent weight loss," Schauer said. "It falls below expectations."
On a positive note, fewer patients had serious side effects related to the therapy than the researchers expected -- about 4 percent rather than the anticipated 15 percent, according to the study. Common side effects attributed to therapy were heartburn, indigestion and abdominal pain.
The device is being considered for approval by the U.S. Food and Drug Administration, Billington noted.
"If it is approved, it would be the first device for obesity treatment approved in 10 years and could provide an additional treatment option beyond the currently available medication and surgery," he said.
In another study in the same journal issue, an analysis of all the weight loss surgeries done in Michigan found that sleeve gastrectomy has become more common than Roux-en-Y gastric bypass surgery.
Both Roux-en-Y gastric bypass surgery and sleeve gastrectomy are types of weight loss -- or bariatric -- surgeries that make the stomach smaller. In a sleeve gastrectomy, a large part of the patient's stomach is removed. In a Roux-en-Y gastric bypass, a part of the stomach is used to create a pouch -- essentially a new smaller stomach.
Although long-term outcomes of sleeve gastrectomy are still unclear, it might be more popular because it seems to have a favorable safety profile. And, weight loss may continue for at least two to three years after the surgery, the researchers said.
Schauer said that sleeve gastrectomy may be increasing in popularity because many patients and doctors prefer it.
"Patients seem to want a less invasive option. Also, more surgeons are trained to do sleeve gastrectomy than Roux-en-Y gastric bypass surgery because it is an easier procedure to perform," he said.
More information
For more about obesity, visit the U.S. National Library of Medicine (http://www.nlm.nih.gov/medlineplus/obesity.html ).
SOURCES: Charles Billington, M.D., endocrinologist, weight management specialist, University of Minnesota, Minneapolis; Philip Schauer, M.D., bariatric surgeon, and director, Bariatric and Metabolic Institute, Cleveland Clinic, Ohio; Sept. 3, 2014, Journal of the American Medical Association
by Steven Reinberg

More Global Help Needed to Fight Ebola Outbreak

Window of opportunity to stop its spread closing, CDC and WHO say
TUESDAY, Sept. 2, 2014 (HealthDay News) -- As the Ebola outbreak continues to overwhelm health-care workers in three West African nations, medical experts from the United States and the United Nations called on Tuesday for a concerted international response to stem history's biggest outbreak of the often-fatal virus.
Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, said that without a greater global commitment in resources -- both medical and financial -- the epidemic will continue to spread and the number of new cases will continue to grow.
"There is a window of opportunity to stop the epidemic now, but that window is closing," Frieden said at a noon ET news conference. "We need action now. We know how it spreads. We know how to stop it," he said.
"The number of cases continues to increase and is now increasing rapidly," added Frieden, who returned Monday from a trip to West Africa, home to the hardest hit countries -- Guinea, Liberia and Sierra Leone.
The Ebola outbreak, with a mortality rate that can approach 90 percent, has killed more than 1,500 people in West Africa.
According to Frieden, the way to beat back the epidemic is with more resources, such as labs to diagnose the disease, doctors to treat it, specialists to coordinate the response and outreach to educate people.
He said Ebola is primarily spread in two ways. The first way, among people caring for people with the disease, whether at home or in health-care settings and hospitals. The second way: unsafe burial practices.
"This is not just a problem for West Africa, it is a problem for the world and the world needs to respond," said Frieden, suggesting that wealthy nations have a responsibility to join the fight against the disease.
Frieden noted that since March the U.S. government has committed $20 million to combat the outbreak. In addition, the WHO has asked for nations to commit $450 million to the fight, he said.
Unlike easily spread infectious diseases such as the flu or tuberculosis, Ebola is spread by direct contact with the blood, secretions, organs or other bodily fluids of infected people, or indirect contact with "environments contaminated with such fluids," according to the World Health Organization.
The international group Doctors Without Borders echoed on Tuesday Frieden's warnings about the dire nature of the Ebola outbreak and the race against time to contain it. The group said treatment centers in West Africa have been "reduced to places where people go to die alone."
In a briefing to the United Nations, Doctors Without Borders President Joanne Liu said that in West Africa, "cases and deaths continue to surge. Riots are breaking out. Isolation centers are overwhelmed. Health workers on the front lines are becoming infected and are dying in shocking numbers. Others have fled in fear, leaving people without care for even the most common illnesses. Entire health systems have crumbled."
Last week, the World Health Organization predicted that as many as 20,000 people could become infected within three months in Guinea, Liberia and Sierra Leone, Liu noted.
World Health Organization Director Margaret Chan said Tuesday that the outbreak will "get worse before it will get better." And, like the CDC's Frieden, she said that what's needed is a "larger global response. We need more from you. And we also need those countries that have not come on board," the Associated Press reported.
Meanwhile, another American doctor working in West Africa for a missionary group has become infected with the Ebola virus.
The missionary group, Serving In Mission (SIM), said Tuesday that the unidentified doctor had been treating women in the obstetrics ward of a hospital in the Liberian capital. It's not clear how the doctor contracted the virus because the ward is separate from the part of the hospital where Ebola patients are treated, the AP reported.
Last month two American health-care workers, including one with SIM, were infected with Ebola in Liberia and evacuated to Emory University Hospital in Atlanta. They recovered after aggressive treatment that included the experimental drug known as ZMapp.
The manufacturer says it has run out of supplies of the drug and it will take months to produce more, the AP said.
Also Tuesday, the U.S. National Institutes of Health (NIH) said the first human tests of an experimental Ebola vaccine are set to start this week.
The vaccine, which the NIH is developing with drug company GlaxoSmithKline, has "performed extremely well" in primates, but hasn't yet been tested in people, Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said in a statement, ABC News reported.
The phase 1 clinical trial with 20 people, ages 18 to 50, will begin this week at the NIH Clinical Center in Bethesda, Md., and is meant to determine if the vaccine is safe and whether it triggers an immune response that would protect against Ebola.
Ebola vaccine trials will also begin this month in England, Gambia and Mali, GlaxoSmithKline said.
The vaccine is different than the experimental Ebola drug ZMapp, which is meant to treat Ebola infection rather than prevent it.
More information
For more on Ebola, visit the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/vhf/ebola/ ).
SOURCES: Sept. 2, 2014, news conference with Thomas Frieden, M.D., M.P.H., director, U.S. Centers for Disease Control and Prevention; Sept. 2, 2014, news release, Doctors Without Borders; Associated Press; ABC News
by Steven Reinberg

'Pot Addiction' May Be Real, Study Suggests

Many teen marijuana users exhibited withdrawal symptoms when they tried to quit, researchers say
TUESDAY, Sept. 2 (HealthDay News) -- Many people believe that marijuana is not addictive, but a new study challenges that theory.
"As more people are able to obtain and consume cannabis legally for medical and, in some states, recreational use, people are less likely to perceive it as addictive or harmful," study co-author John Kelly, a psychiatrist at Massachusetts General Hospital's Center for Addiction Medicine, said in a hospital news release.
"But research shows that cannabis use can have significant consequences, and we know that among adolescents it is second only to alcohol in rates of misuse," he added.
In the new study, Kelly's team followed outcomes for 127 teens, ages 14 to 19, treated at an outpatient substance abuse clinic. Marijuana was the substance used most often by 90 of the teens.
Of those 90 teens, 76 (84 percent) met criteria for marijuana dependence, including increased tolerance for, and use of, marijuana, as well as unsuccessful attempts to reduce or stop using the drug. About two-fifths of the 90 teens also experienced symptoms of withdrawal when they stopped using marijuana -- a sign of drug dependence, according to the study authors.
Teens who exhibited withdrawal symptoms were more likely to experience negative consequences such as trouble at school or on the job, or financial or relationship problems, Kelly's team said.
The teens who developed withdrawal symptoms were also more likely to meet the guidelines for marijuana dependence and for mood disorders, according to the study published recently in the Journal of Addiction Medicine.
People who recognized and accepted that they had a substance abuse problem tied to their marijuana use were more likely to make progress towards abstinence, compared to those who did not think they had a problem, the researchers noted.
"The importance of understanding the addictiveness, risks and harms associated with cannabis use is a major theme of this study's findings," said said Kelly, an associate professor of psychiatry in addiction medicine at Harvard Medical School in Boston. "Recognizing those risks is known to reduce the likelihood that someone will start to use drugs, and better understanding of the role of substances in the problems experienced by patients may help them cut down on future use."
"Unfortunately, the general trend in attitudes in the U.S. is to minimize the risks and not recognize the addictiveness of cannabis," he added.
The study was supported by a grant from the U.S. National Institute of Alcohol Abuse and Alcoholism.
More information
There's more on teens and marijuana at the U.S. National Institute on Drug Abuse (http://teens.drugabuse.gov/drug-facts/marijuana ).
SOURCE: Massachusetts General Hospital, news release, Sept. 2, 2014
by Steven Reinberg

'Spare Tire' May Be Especially Bad for Your Blood Pressure

Weight gain around the middle was key to rising risk for hypertension, study found
TUESDAY, Sept. 2, 2014 (HealthDay News) -- When it comes to excess pounds and blood pressure, all fat may not be created equal, a new study finds.
The research found that belly fat -- the proverbial "spare tire" -- boosts a person's odds for high blood pressure more than overall body fat.
It's well known that obesity raises the risk of high blood pressure. But it wasn't clear how the location of fat in the body affects that risk, according to researchers at University of Texas Southwestern Medical Center in Dallas.
Reporting Sept. 1 in the Journal of the American College of Cardiology, the researchers tracked more than 900 people for an average of seven years. The study participants were checked for fat located deep in the abdomen between the organs (so-called "visceral fat"), fat located all over the body, and fat located on the lower body.
"Generally speaking, visceral fat stores correlate with the 'apple shape' as opposed to the 'pear shape,' so having centrally located fat when you look in the mirror tends to correlate with higher levels of fat inside the abdomen," study senior author Dr. Aslan Turer, a cardiologist at the medical center, explained in a journal news release.
One in every four of the study participants developed high blood pressure by the end of the follow-up period. After factoring in where fat was located in the body, the researchers found that only the abdominal fat was independently associated with high blood pressure. This link was present regardless of age, gender or race, the researchers noted.
The strongest connection between abdominal fat and high blood pressure was seen with fat located around the kidneys, which suggests "that the effects from fat around the kidneys are influencing the development of hypertension [high blood pressure]," Turer said.
This is a new finding that "could open new avenues for the prevention and management of hypertension," he added.
More information
Find out more about high blood pressure at the American Heart Association ( http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/About-High-Blood-Pressure_UCM_002050_Article.jsp ).
SOURCE: Journal of the American College of Cardiology, news release, Sept. 1, 2014
by Steven Reinberg

Action-Packed TV a Threat to Your Waistline?

Viewers of fast-paced films filled up on more snacks, study found
MONDAY, Sept. 1, 2014 (HealthDay News) -- Watching action shows on TV may be bad for your waistline, a new study contends.
People eat much more snack food while watching action films and programs than something less exciting, according to the Cornell University researchers.
"We find that if you're watching an action movie while snacking your mouth will see more action too," study author Aner Tal, of the Cornell Food and Brand Lab, said in a university news release. "In other words, the more distracting the program is, the more you will eat."
The study included 94 undergraduate students who were provided with M&Ms, cookies, carrots and grapes while they watched 20 minutes of television. One-third of the participants watched a segment of the action movie "The Island" while another third watched the Charlie Rose show, and the final third watched the same segment of "The Island" without sound.
"People who were watching 'The Island' ate almost twice as many snacks -- 98 percent more than those watching the talk show," study co-author Brian Wansink, director of the Cornell Food and Brand Lab, said in the news release.
"Even those watching 'The Island' without sound ate 36 percent more," he added.
Participants who watched the action movie also consumed more calories -- 354 calories with sound and 314 without sound -- than those who watched the interviewer Charlie Rose (215 calories).
"More stimulating programs that are fast-paced, include many camera cuts, really draw you in and distract you from what you are eating. They can make you eat more because you're paying less attention to how much you are putting in your mouth," Tal said.
Before you watch an action movie, you should prepare limited portions of snacks instead of grabbing a whole bag of chips or box of cookies, the researchers suggested. Even better, stick to healthy snacks such as carrots.
"The good news is that action movie watchers also eat more healthy foods, if that's what's in front of them. Take advantage of this," Wansink said.
The study was published Sept. 1 in the journal JAMA: Internal Medicine.
More information
The U.S. Centers for Disease Control and Prevention outlines how to prevent weight gain (http://www.cdc.gov/healthyweight/prevention/index.html ).
SOURCE: Cornell University, news release, Sept. 1, 2014
by Steven Reinberg

ADHD Medications Won't Stunt Kids' Growth, Study Finds

Research suggests that stimulant drugs don't affect adult height
TUESDAY, Sept. 2, 2014 (HealthDay News) -- Stimulant medications -- such as Adderall, Ritalin and Concerta -- used to treat attention-deficit/hyperactivity disorder (ADHD) in children, won't stunt their growth, a new study suggests.
"Stimulant medication did not affect children's final height as adults," said study researcher Dr. Slavica Katusic, an associate professor of pediatrics at the Mayo Clinic in Rochester, Minn.
Katusic noted that results of earlier studies have been mixed, with some showing these drugs retard growth and others showing they don't. But, most of the previous studies had limitations, such as having too few children or spotty information about adult height, she said.
Katusic said this study is unique because it followed a group of people with ADHD who were taking stimulant medications and compared them with a group with ADHD who were not taking medication and also a group that didn't have ADHD. These individuals were followed from childhood to adulthood, she said.
ADHD is one of the most common disorders of childhood, according to the U.S. National Institute of Mental Health (NIMH). Symptoms include difficulty paying attention or staying focused on one task, overactivity and impulsive behavior, the NIMH explains.
Stimulant medications are a mainstay of ADHD treatment, and while it may seem odd to use stimulant medication on an overactive child, stimulant drugs have a calming, focusing effect on youngsters with ADHD, according to the NIMH. Katusic said these drugs are important for improving school and social functioning.
Katusic's team studied 340 children with ADHD and 680 without the condition. "We compared the height when they were children and when they were grown up," she said.
The average follow-up time was 26 years for those with ADHD and 23 years for people without ADHD. Approximately 70 percent of those with ADHD who completed the study had taken stimulant medication for more than three months, the researchers noted.
There was no difference in adult height between those who took ADHD drugs and those who didn't, the investigators found.
"Neither childhood ADHD itself nor stimulant medication was associated with shorter stature as adults," Katusic said.
Boys with ADHD who were treated with stimulants for three or more months had a later growth spurt than boys who didn't take these drugs, but there was no difference in the size of the growth spurt, the researchers noted.
In addition, no connection was seen between the amount of time a child took stimulant drugs and adult height, the study authors found.
"But despite our findings, doctors should monitor growth when making medication decisions," she said. "Our study says don't worry at all, but human beings are all different and you always have to be careful."
The report was published online Sept. 1 in the journal Pediatrics.
Dr. Marcel Deray, a pediatric neurologist at Miami Children's Hospital, said, "This is good news, because we discuss this issue with parents of kids with ADHD."
Deray hopes the study will be replicated to prove the point that these stimulants don't affect height. "It would good to have a couple of studies showing the same thing," he said.
He also said this finding should be reassuring to parents who may be reluctant to allow their children to use these drugs because of the potential risk of stunting their child's growth.
More information
For more about ADHD, visit the U.S. National Institute of Mental Health (http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml ).
SOURCES: Slavica Katusic, M.D., associate professor, pediatrics, Mayo Clinic, Rochester, Minn.; Marcel Deray, M.D., pediatric neurologist, Miami Children's Hospital; October 2014, Pediatrics
by Steven Reinberg

Booze, Pot Bad for Teens in Different Ways, Study Suggests

Drinking tied to unsafe driving, marijuana use linked to poorer academics, job performance
TUESDAY, Sept. 2, 2014 (HealthDay News) -- Drinking and marijuana may lead to different types of harmful consequences for teens, a new study suggests.
Researchers analyzed 2007 to 2011 data gathered from more than 7,400 U.S. high school seniors who said they had used alcohol or marijuana at least once.
The investigators found that drinking alcohol was associated with more unsafe driving, damage to relationships with friends and romantic partners, and regret about actions while under the influence of alcohol, especially among females.
On the other hand, marijuana use was more often tied to worsening relationships with teachers or supervisors, less energy or interest, and poorer school or job performance, according to the NYU researchers.
"Nearly half of high school seniors have used marijuana in their lifetime and over two-thirds have used alcohol, but few studies have compared adverse psychosocial outcomes of alcohol and marijuana directly resulting from use," study author Joseph Palamar, a researcher affiliated with the NYU Center for Drug Use and HIV Research, said in a university news release.
The most "alarming finding" was the degree to which drinking was tied to reckless, unsafe driving among youth, Palamar said. "Compared to non-drinkers, frequent drinkers were over 13 times more likely to report that their alcohol use has led to unsafe driving. Marijuana users, compared to non-users, were three times more likely to report unsafe driving as a direct result of use," he noted.
"Not unexpectedly, we found that the higher the frequency of use [of alcohol or pot], the higher the risk of reporting an adverse outcome," Palamar added.
Among people who said they regretted past actions, the likelihood of regret was higher among frequent drinkers than among those who used marijuana, he said.
The study could only point to associations between drinking or pot use and various outcomes; it could not prove cause and effect. The research was published Sept. 2 in the American Journal of Drug and Alcohol Abuse.
The researchers noted that growing support for marijuana legalization in the United States has led to debate about whether marijuana is safer than alcohol and other substances.
"We hope that the findings of this study will contribute to the ongoing debate on marijuana policy and its perceived harm when compared to alcohol," Palamar said.
More information
There's more on teens and drinking at the U.S. National Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov/alcohol-health/special-populations-co-occurring-disorders/underage-drinking ).
SOURCE: New York University, news release, Sept. 2, 2014
by Steven Reinberg

Daily Exercise May Halve Risk for Heart Failure, Study Says

Higher levels of activity reap greater benefits, researchers find
TUESDAY, Sept. 2, 2014 (HealthDay News) -- Daily exercise may significantly reduce the risk of heart failure, according to new research.
Heart failure, a common, disabling condition in older adults, was nearly half as likely in those who got an hour of moderate exercise or a half hour of vigorous exercise every day, researchers in Sweden found.
"The study shows that high levels of physical activity are associated with considerably lower risk of heart failure," said study researcher Dr. Kasper Andersen, a physician at Uppsala University.
It's important to note that Andersen's study found a link, not a proven cause-and-effect relationship, between activity and lower heart failure risk. Even so, he said, the association makes sense. Physical activity is known to lower the risk of developing high blood pressure, for instance, which is a risk factor for heart failure.
Exercise also lowers the odds of developing obesity and diabetes, which boost the risk of heart failure, he said. Even after adjusting for those risk factors in the study, he said, physical activity still lowered the risk of heart failure.
For the study, the researchers evaluated nearly 40,000 adults of all ages who supplied information on a regular basis to a national Swedish database beginning in 1997. None had heart failure when they began the study.
Andersen's team evaluated their total and leisure time activity and then looked at how it related to their risk of getting heart failure later.
By 2010, about 4 percent had been hospitalized for heart failure -- the heart's inability to pump enough blood and oxygen to the body's other organs.
Nearly 6 million Americans have congestive heart failure, according to the Centers for Disease Control and Prevention. As many as half of those people die within five years of their diagnosis.
In the study, published Sept. 2 in the journal Circulation: Heart Failure, the group with the highest activity levels -- more than one hour of moderate or half an hour of vigorous activity daily -- had a 46 percent lower risk of developing heart failure.
The study findings reinforce recommendations to get at least 150 minutes of moderate intensity exercise a week, Andersen said. Higher-level activity can produce additional benefit, he said.
The study data didn't include what type of exercise was done. However, Andersen recommends exercise aimed at cardiovascular conditioning, such as jogging or walking. However, any type of activity is better than nothing, he said.
The study also didn't address whether starting to exercise at midlife is too late to obtain benefits. However, Andersen said, "I think there is good evidence [from other research] that no matter at what age you start to exercise, it has positive effects on your health."
While many studies have looked at the link between exercise and heart disease risk, few have looked at the specific link between exercise and the risk of developing heart failure, said Dr. Gregg Fonarow, professor of cardiology at the University of California, David Geffen School of Medicine.
Fonarow, who wasn't involved in the study, agreed with Andersen that exercise has many favorable effects -- on blood pressure, blood cholesterol and heart muscle health, for instance.
"Exercise lowers the risk of heart attack, which in turn can lower the risk of subsequent heart failure," said Fonarow, a spokesman for the American Heart Association. "There may be other favorable effects of exercise that directly impact the risk of heart failure."
Some other studies have shown that even after heart failure is diagnosed, patients can benefit from exercise, Fonarow said. "Exercise and cardiac rehabilitation programs are recommended in national guidelines for the treatment of heart failure," he added.
The bottom line? "If preventing heart attacks, strokes, diabetes and premature cardiovascular death were not enough," said Fonarow, "this study provides an additional rationale for all adults to engage in regular physical activity."
More information
To learn more about exercising with a heart condition, visit National Jewish Health ( http://www.nationaljewish.org/healthinfo/conditions/cardio/exercise-and-heart-disease/ ).
SOURCES: Kasper Andersen, M.D., Ph.D., researcher, Uppsala University, Uppsala, Sweden; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles David Geffen School of Medicine, and spokesman, American Heart Association; Sept. 2, 2014 Circulation: Heart Failure
by Steven Reinberg

Double Mastectomy Doesn't Improve Survival, Study Finds

But many more women in U.S. are choosing the radical procedure
TUESDAY, Sept. 2, 2014 (HealthDay News) -- More U.S. women with early stage breast cancer are choosing to have both breasts removed as a precautionary step, although the double mastectomy provides no apparent survival advantage, researchers say.
Death rates are similar for women who have both breasts taken off and those who opt for breast-conserving surgery known as lumpectomy, according to their new study.
"We found no lower death rates among women who had bilateral mastectomy compared to women who had breast-conserving surgery with radiation," said study researcher Scarlett Gomez, a research scientist at the Cancer Prevention Institute of California.
The results are important for women at average risk of breast cancer, Gomez and other experts said.
Tracking health data on more than 189,000 breast cancer patients in California, researchers found that the number of women opting for double -- or bilateral -- mastectomy jumped from 2 percent in 1998 to 12.3 percent in 2011.
One-third of women younger than 40 opted for a double mastectomy in 2011, compared to less than 4 percent at the study's start, the researchers said.
The study, published Sept. 3 in the Journal of the American Medical Association, followed most of the patients for at least seven years.
The preventive, or prophylactic, double mastectomy has been in the spotlight recently. In 2013, actress Angelina Jolie announced she had had a preventive double mastectomy because of a strong family history of breast and ovarian cancer. She'd also tested positive for the genetic mutation BRCA1, which raises breast cancer risk.
Gomez said her team realized the proportion of women opting for double mastectomy had surged in recent years and wanted to see what effect the more extensive surgery had on survival. The radical surgery is associated with higher costs, longer recovery and greater risk of complications.
Using information from a California cancer registry, they looked at survival after double mastectomy, breast-conserving therapy (lumpectomy) with radiation, and single mastectomy (removal of one breast) in women who had early cancer in one breast. The registry didn't include genetic information that might have indicated raised breast cancer risk.
Death rates were similar between women having double mastectomy and breast-conserving surgery, the researchers said. However, the death rate associated with single mastectomy was higher than the other procedures. "That is not a new finding," Gomez said. The higher rate is thought to be linked with other factors, such as the presence of other health conditions.
Over 10 years, survival was 83 percent for those who had lumpectomy, 81 percent for those who underwent double mastectomy and nearly 80 percent for a single mastectomy.
The findings echo those of other recent studies, Gomez said.
Women need this information when deciding on the surgical treatment of their breast cancer, Gomez said.
Oftentimes, survival rates are just one of many factors a woman considers when weighing surgical treatment for breast cancer, she said. A common reason for double mastectomy is fear of cancer recurrence, even though the fear usually exceeds the estimated risk, she said.
For some women, aesthetics are a key consideration, the researchers wrote. Some newer reconstruction techniques produce better breast symmetry if both are reconstructed at the same time.
Being informed is essential, said Dr. Lisa Newman, director of the Breast Care Center at the University of Michigan, who wrote an editorial accompanying the study. "Overall, I think the important message [from this study] for our breast cancer patients is there is no overwhelming survival advantage," she said.
As long as women understand the pros and cons of the procedures, "it really does become a very personal choice," she added.
Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, agreed. Doctors need to communicate these study findings to their patients who are deciding about surgical treatment of their breast cancer, he said.
Lichtenfeld, who had no part in the study, advises women to take time after their diagnosis to learn about the pros and cons of each approach.
No matter which option she chooses, a woman's decision about surgical treatment needs to be respected, Lichtenfeld said. "If a woman is educated [about her options] and makes a decision, that is her decision."
More information
For more about surgical options for breast cancer, visit the American Cancer Society ( http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer-overview-treating-surgery ).
SOURCES: Scarlett Gomez, Ph.D., research scientist, Cancer Prevention Institute of California, Fremont; Lisa Newman, M.D., M.P.H., professor, surgery, and director, Breast Care Center, University of Michigan, Ann Arbor; Len Lichtenfeld, M.D., M.A.C.P., deputy chief medical officer, American Cancer Society; Sept. 3, 2014 JAMA
by Steven Reinberg

Drug Gives 'New Hope' Against Heart Failure, Expert Says

Experimental medication beat standard treatment at reducing hospitalizations, cardiovascular deaths
SATURDAY, Aug. 30, 2014 (HealthDay News) -- In a head-to-head comparison, an experimental drug was more effective than standard treatment at preventing deaths and hospitalizations in heart failure patients.
According to the study authors, the trial was stopped early because of the marked benefit of the new drug, dubbed LCZ696.
In the trial, 26.5 percent of those getting the standard medication, enalapril (Vasotec), either died or were hospitalized due to heart failure, compared with 21.8 percent of those on the new drug. Enalapril belongs to a class of blood pressure-lowering medications known as ACE inhibitors.
"LCZ696 could become the new gold standard, replacing ACE inhibitors," said lead researcher Dr. John McMurray, a professor of cardiology at the British Heart Foundation Cardiovascular Research Center at the University of Glasgow, in Scotland.
LCZ696 combines two blood pressure drugs -- an angiotensin II receptor blocker (ARB) and the neprilysin inhibitor known as sacubitril.
"We found that LCZ696 was superior to the gold-standard ACE inhibitor for heart failure -- an ACE inhibitor being the absolute cornerstone of treatment for this problem," he said.
Not only did LCZ696 beat enalapril, but it did that even when added to other treatments, McMurray noted.
"The new treatment was very well tolerated, with no significant safety concerns," he added.
The report was published online Aug. 30 in the New England Journal of Medicine, to coincide with a presentation at the European Society of Cardiology annual meeting in Barcelona. The trial was funded by Novartis, the maker of LCZ696.
Dr. Mariell Jessup, a professor of medicine at the University of Pennsylvania's Perelman School of Medicine, said, "There is new hope for heart failure."
She added, "We have not had a new drug for heart failure for many years. LCZ696 is a unique compound that may represent a new approach."
Doctors have relied on ACE inhibitors for over two decades, she said. According to Jessup, who wrote an accompanying editorial, "Newer drugs that work via alternate pathways may [show] benefit beyond the medical therapy that is used today."
For the study, over 8,400 patients with heart failure were randomly chosen to receive LCZ696 or enalapril.
Over an average of 27 months of follow-up, LCZ696 reduced the risk of hospitalization for heart failure by 21 percent, compared to enalapril, the findings showed.
Moreover, among the 1,251 people who died from heart disease during the trial, 558 were taking LCZ696 (13.3 percent) and 693 were taking enalapril (16.5 percent), the researchers noted.
Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, commented, "The results of this study are terrific news for patients with heart failure, and represent landmark findings."
If approved by the U.S. Food and Drug Administration, this new medication should help doctors improve outcomes for the millions of men and women with chronic heart failure worldwide, he said.
More information
Visit the American Heart Association (http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp ) for more on heart failure.
SOURCES: John McMurray, M.D., professor, cardiology, British Heart Foundation Cardiovascular Research Center, University of Glasgow, U.K., Mariell Jessup, M.D., professor, medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Gregg Fonarow, M.D., professor, cardiology, University of California, Los Angeles; Aug. 30, 2014, New England Journal of Medicine, online; Aug. 30, 2014, presentation, European Society of Cardiology annual meeting, Barcelona

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